This paper examines the State's assumption of medical care for patients with "permanent needs" in 19th century Spain. These patients were the incurably ill, the chronically ill and the elderly. This process is contextualized within the liberal reforms of the Spanish healthcare system in the reign of Isabel 11 (1833-1868). The goal of these reforms was the creation and consolidation of a national health system that would gradually replace the religious health charities. Healthcare reform became necessary due to the increase in migration that started in the 1830's and intensified in the 1850's. Traditional care networks formed by the family, local community and religious charities were no longer available to those who had left their village or town. In addition, many religious charities were bankrupted by the seizure of their properties in a programme of confiscation. Similar healthcare reform processes were taking place in the United Kingdom, France and Germany, among other European countries, and involved significant changes in the lives of patients, who became strictly controlled and medicalised. My aim was to identify changes in the patients' experience of illness through a case study of the living conditions of inmates at the Nuestra Señora del Carmen Hospital for Incurable Men, based in Madrid from 1852 to 1949. This was one of the institutions devoted to caring for patients with "permanent needs" and was under the direct control of the General State Administration.